Eligibility Specialist

Maintain up-to-date knowledge of regulations involving government sponsored programs, hospital charity care policies, and other financial assistance programs, including eligibility criteria and application procedures.

Assess patients’ financial situations to determine eligibility for government sponsored programs, charity care, or other financial assistance programs through interviews, document reviews, and verification processes.

Guide patients through the completion and submission of applications for government sponsored programs, hospital charity care, and other relevant programs, ensuring all required documentation is accurate and complete.

Act as a liaison between patients and program administrators, advocating for patients to ensure timely processing of applications and resolution of issues.

Maintain accurate and confidential records of patient interactions, eligibility assessments, and application statuses in compliance with hospital policies and applicable regulations.

Educate patients and families about available financial assistance options, explaining complex program details in a clear and empathetic manner.

Work closely with hospital billing, social work, and case management teams to coordinate patient care and financial support services.

Ensure all activities adhere to federal, state, and hospital regulations, including HIPAA, regarding patient privacy and financial assistance processes.

Verify and correctly assign insurance coverages based on eligibility responses. 

Perform all other duties as assigned.

Work Schedule: PRN, As Needed

Qualifications/Training:

1. Minimum of two (2) years of experience in healthcare, social services, insurance, or government payor programs preferably in patient financial services or case management.

2. Strong understanding of government sponsored programs, insurance, and charity care programs or ability to quickly learn program requirements.

3. Excellent communication and interpersonal skills to interact with diverse patient populations.

4. Detail-oriented with strong organizational skills to manage multiple applications and deadlines.

5. Proficiency in Microsoft Office and electronic health record (EHR) systems.

6. Ability to handle sensitive information with confidentiality and professionalism.

7. Compassionate, patient-focused, and ability to work effectively under pressure in a fast-paced hospital environment.

Licenses/Certifications/Registrations/Education

1. High school diploma or equivalent required.
2. Associate’s or bachelor’s degree in healthcare administration, social work, or related field preferred.